Provider Demographics
NPI:1720471766
Name:BRIEN, VANESSA (PSYD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BRIEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 SUNRISE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4504
Mailing Address - Country:US
Mailing Address - Phone:916-782-3800
Mailing Address - Fax:916-782-3820
Practice Address - Street 1:729 SUNRISE AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4504
Practice Address - Country:US
Practice Address - Phone:916-782-3800
Practice Address - Fax:916-782-3820
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006665101YP2500X
CAPSY32036103TC0700X
CAPSB94025332103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical